| Background:Polycystic ovary syndrome(PCOS)is the most common endocrine disease in obstetrics and gynecology.PCOS can run through a woman’s life.It not only affects the endocrine system function of women,but also leads to other long-term complications that are harmful to women’s health,such as diabetes,hypertension,hyperlipidemia,cardiovascular and cerebrovascular diseases,etc.Patients often present with irregular menstruation,and about 20%-30% of infertility in patients is caused by PCOS.As PCOS is a complex,multi-system endocrine and metabolic disease,and its main clinical features include hyperandrogenemia and insulin resistance,there are many differences and great controversies on the diagnostic criteria of PCOS.At present,the diagnostic criteria of PCOS proposed by the European Society of Human Reproduction and Embryology(ESHER)and The American Society of Reproductive Medicine(ASRM)in Rotterdam conference in May 2003 are often used internationally [1].Although most PCOS patients successfully conceive after conventional treatment,some patients still cannot conceive naturally and require Assisted reproductive technology(ART)to achieve pregnancy.Common clinical manifestations of PCOS include infertility,menstrual disorders,obesity,acne,hirsutism and so on.Compared with the patients with infertility caused by tubal factors alone,PCOS patients are often accompanied by the characteristic manifestation of obesity,nearly 50% of PCOS patients are obese,and some reports even up to 70%[2].Body Mass Index(BMI)is a commonly used measure of how obese a person is.Obese PCOS patients have more severe insulin resistance than non-PCOS patients with the same BMI [3].Obesity will have a certain impact on the reproductive function of PCOS patients,Which may affect patients’ eggs In vitro fertilization/intracytoplasmic sperm injection and embryo transplantation(In vitro fertilization/intracytoplasmic sperm injection and embro transfer,IVF-ET)help pregnant outcome.Some studies suggest that there is no significant difference in the outcome of assisted pregnancy between obese patients and normal weight patients [4].Studies have shown that high or low BMI may interfere with the function of endometrium,thus reducing the receptivity of endometrium and affecting the pregnancy rate of patients [5].Some studies also believe that obesity causes the increase in the use of ovulation-promoting drugs,cycle cancellation rate,fewer eggs harvested,lower pregnancy rate and higher spontaneous abortion rate in the treatment process [6].At present,although there are many domestic and foreign studies on the influence of BMI on IVF/ICSI cycle treatment process and pregnancy outcome of PCOS patients,the results of the studies are not completely consistent.Objective:To investigate the effect of different body mass index on In vitro fertilization and embryo transfer assisted pregnancy outcomes in PCOS infertile patients,in order to provide reference for the treatment of assisted pregnancy in PCOS patients with different BMI.Research Methods:The clinical data of patients who received in vitro fertilization-embryo transfer assisted pregnancy treatment in the Reproductive Center of Henan Provincial People’s Hospital from January 2017 to December 2019 were retrospectively analyzed.Inclusion criteria: 1)The female’s age <35;2)Patients diagnosed with PCOS strictly according to diagnostic criteria.PCOS diagnosis was based on Rotterdam PCOS diagnosis and treatment standard in 2003.Exclusion criteria: 1)female patients with endometriosis or adenomyosis;2)Female patients with hypertension,hyperglycemia and other endocrine diseases;3)BMI<18.5kg/m2;4)The woman has a history of ovarian surgery and other diseases affecting fertility;5)Patients with either male or female with clinically significant chromosomal abnormalities.A total of 2484 treatment cycles were identified for young PCOS patients who received assisted reproductive technology.Among them,PCOS patients who met the conditions had A total of 1238 cycles of stimulation,which was divided into group A,390 cycles of fresh cycle embryo transfer,which was divided into group B,and 1246 cycles of freeze-thaw cycle embryo transfer,which was divided into group C.The clinical data of 3 groups were studied respectively.According to BMI values(Guidelines for the Prevention and Control of Overweight and Obesity in Chinese adults),the cases of pregnancy promotion cycle in group A,fresh cycle in group B and freeze-thaw cycle in group C were divided into 3 groups.Normal weight group(18.5≤BMI<24.0 kg/m2)(A1 group,B1 group,C1 group);Overrecombinant(24≤BMI<28.0 kg/m2)(A2 group,B2 group,C2 group);BMI of obese group(BMI≥28.0 kg/m2)(A3 group,B3 group,C3 group).Age,infertility years,number of basal sinus follicles(AFC),basal hormone level,ovulation induction program,duration of Gonadotrophin(Gn)administration,and Gn in group A were analyzed The dosage,intrauterine membrane thickness on HCG day,hormone level on HCG day,number of large follicles on HCG day,number of harvested eggs,number of 2PN and number of M ⅱ were compared.The age,infertility years,endometrial thickness on transplantation day,average number of transplanted embryos,embryo implantation rate,clinical pregnancy rate,ectopic pregnancy rate,multiple pregnancy rate,abortion rate,live birth rate and premature birth rate of patients in group B were compared among groups.The age,infertility years,endometrial thickness on transplantation day,average number of transplanted embryos,embryo implantation rate,clinical pregnancy rate,ectopic pregnancy rate,multiple pregnancy rate,abortion rate,live birth rate and premature birth rate of patients in group C were compared between groups.Results:There were no statistically significant differences in ovulation induction program and insemination method among the three groups in group A(P >0.05).The total amount of Gn used in A3 group was much more than that in the other two groups(P <0.01).The daily E2 value of HCG in A3 group was lower than that in A1 group,and the difference was statistically significant(P <0.05).The daily intima thickness of A3 group was thinner than that of A1 group,and the difference was statistically significant(P <0.05).The number of large follicles on HCG day in A3 group was lower than that in A1 group,the difference was statistically significant(P <0.05).The total number of eggs in A3 group was much less than that in the other two groups,the difference was statistically significant(P <0.01),and there was no statistical difference in the total number of eggs in the other two groups(P >0.05).The number of 2PN and M ⅱ in A3 group was lower than that in A1 group,and the differences were statistically significant(P <0.05).There was no statistical difference in other observation indexes.There were no significant differences in age,endometrial thickness and average number of transplanted embryos among the three groups in group B(P >0.05).The duration of infertility in B3 group was longer than that in the other two groups,with statistical significance(P <0.05),while there was no statistical difference between the other two groups(P >0.05).There were no significant differences in embryo implantation rate,clinical pregnancy rate,ectopic pregnancy rate,multiple pregnancy rate,abortion rate,premature birth rate and live birth rate among 3 groups(P >0.05).There were no significant differences in age,endometrial thickness on transplantation day and average number of transplanted embryos among the three groups in group C(P >0.05).The years of infertility in C3 group were longer than those in the other two groups,with statistical significance(P <0.05),while there was no statistical difference between the other two groups(P >0.05).There were no significant differences in embryo implantation rate,clinical pregnancy rate,ectopic pregnancy rate,multiple pregnancy rate,abortion rate and premature birth rate among 3 groups(P >0.05).The live birth rate in C3 group was lower than that in the other two groups,with statistical significance(P <0.05),while there was no statistical difference between the other two groups(P >0.05).Conclusion:The increase of BMI can affect ovulation induction response,leading to the increase of Gn dosage,the extension of the days of ovulation induction,and the decrease of the total number of eggs obtained.Among patients with fresh cycle embryo transfer,the difference in live birth rate among PCOS patients with different BMI did not reach statistical significance,but with the increase of BMI,the live birth rate had a downward trend.In PCOS patients with freeze-thaw cycle embryo transfer,the live birth rate of obese PCOS patients was lower than that of overweight and normal weight PCOS patients. |
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